Chocolate. Wine. Soda. Those foods and beverages you love so much could be causing heartburn. It’s time to reevaluate your strategy. Get the facts about acid reflux and heartburn remedies for fast relief...

Beer and pizza putting a damper on Girls’ Night Out? Are you avoiding broccoli with garlic sauce at your favorite Chinese restaurant or the Sunday brunch buffet?

You’re not suffering alone: Nearly 40% of Americans experience heartburn, or reflux, at least once a month, says the American College of Gastroenterology (ACG). About 60% of adults experience acid reflux symptoms at least once in their lives; 6%-10% endure it daily, says Rashmi Gulati, M.D., medical director of Patients Medical in New York City.

What causes the burning pain in your chest? A digestive system gone haywire. Heartburn occurs when the stomach’s contents slip back into your esophagus, the tube that connects the throat and tummy. The flow should go only one way — down — but a leaky valve allows it back up.

The stomach contains a powerful digestive brew of acids, enzymes and bile, which the esophageal lining can’t handle. With heartburn, you’re feeling its sting in your esophagus.

Acid reflux can affect more than your digestive system. If the stomach’s brew rises high enough, it can reach the throat and change your voice. It can irritate airways and trigger asthma. It’s often mistaken for a heart attack.

Searching for CulpritsIf you’re older than 50, smoke cigarettes or eat poorly, chances are you’re familiar with heartburn. Obesity is a factor in chronic reflux, because a large abdomen is more likely to push stomach acid up into the esophagus, says Janet Horn, M.D., Lifescript’s women’s health expert.

Do you use antibiotics frequently? That, too, can lead to acid reflux, because the medications break down the bacteria needed for proper digestion and cause an imbalance, Dr. Gulati says.

But your diet is the most likely cause of heartburn. Watch out for these triggers:

Wine

Caffeine

Carbonated beverages

Chocolate

Citrus fruits, such as lemons, oranges, tangerines and grapefruit

Tomatoes

Large meals

Fatty foods

Though food is the most common trigger for gastrointestinal issues, a stressful lifestyle increases risk, Dr. Gulati says.

“Skilled trade and blue-collar workers have less heartburn than white collar.”

If you regularly wear tight-fitting underpants, Spanx and control-top pantyhose, tight belts or snug pants, you might have more digestion problems than those who don’t.

Baby and BurnAbout 20% of women feel heartburn in the first trimester of pregnancy, 40% in the second trimester and 70% in the third trimester, Dr. Gulati says.

Blame a surge in progesterone, which relaxes all the smooth muscles and ligaments in the body, she says.

“The lower esophageal sphincter – the opening between the esophagus and stomach – also relaxes,” she says. “As the fetus grows, intra-abdominal pressure increases, which also challenges the sphincter.”

Being overweight or obese before becoming pregnant is a double whammy. And women who had heartburn before pregnancy are more likely to feel discomfort while carrying.

Pregnancy’s cravings can also bring on the burn, so avoid eating junk food or large, high-fat meals, especially late at night.

But when you just can’t resist that pickle, onion and peanut butter sandwich, you can safely ease the pain with natural and over-the-counter remedies.

“Tums is safe in pregnancy and, because of its calcium content, it’s often the first choice,” says Silvia Degli-Esposti, M.D., director of the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative in Providence, R.I.

Gaviscon is also an option, but avoid antacids with magnesium and aluminum during pregnancy, she says.

Studies show that ranitidine hydrochloride (Zantac) and proton pump inhibitors (Nexium) probably are safe, but they should be used only if necessary and under a doctor’s care, she says.

3. Balance the bacteria in your gut with probiotics such as acidophilius, found in yogurt or supplements.

4. Drink warm water 30 minutes before a meal and two hours afterward. Downing a glass of cold water immediately before, during or after eating inactivates digestive enzymes.

5. Take DGL (deglycyrrhizinated licorice) supplements before a meal.

6. Eat some fennel and cardamom seeds or chew mint or mastic gum after meals to calm digestion.

7. Wait an hour after a meal before going to sleep, bending over or exercising.

8. Elevate your head while sleeping.

9. Calcium and magnesium antacids, such as Tums, can help when more natural remedies aren’t enough.

Also test for food allergies – such as gluten – and H. pylori (Helicobacter pylori), which causes stomach troubles, Dr. Gulati advises. The bacteria thrives in the stomach’s acidic environment and damages the organ’s protective lining, triggering inflammation and irritation.

If the test shows the bacteria is out of whack, “work with your doctor to balance it, which will resolve most heartburn and decrease risk of ulcers and cancer,” she says.

Acid Reflux SymptomsBut that burpy, gassy discomfort could be more than a temporary inconvenience.

“People who have daily heartburn or acid regurgitation need to see a physician, because that’s not normal,” says Gary Falk, M.D., a gastroenterologist at the Cleveland Clinic.

If you suffer from regular heartburn and can’t get relief from dietary changes and over-the-counter solutions, you may have a chronic condition: gastroesophageal reflux disorder, or GERD.

Over time, GERD can lead to damaging changes in your digestive tract, including a highly fatal cancer.

When does heartburn progress from an annoyance to a disease?

“When it starts to interfere with the quality of life, when it happens frequently and at night,” says Houssam Mardini, M.D., a gastroenterologist at Cabell Huntington Hospital in Huntington, W.Va.

See a doctor if:

Your heartburn flares up regularly, 2-3 times a week

You’ve been suffering for months

You wake up in the middle of the night with heartburn pain or wake up coughing from regurgitated liquid in your throat

You have pain or difficulty swallowing

Over-the-counter medicines don’t relieve your discomfort

For chronic heartburn, most doctors recommend acid-reducing medication, which should alleviate symptoms and protect against further disease. (These aren’t like over-the-counter antacids, such as Rolaids and Tums, which provide short-term, local relief on the esophagus and stomach by neutralizing acid.)

Two main classes of drugs diminish the amount of stomach acid:

Histamine blockers, such as Zantac, Tagamet and Pepcid

Proton pump inhibitors, such as Prilosec and Nexium

When Heartburn Becomes Harmful As acids burn the esophagus with daily acid reflux symptoms, the tube’s lining can be permanently changed. One problem is strictures, tissue scarring that stiffens and narrows the esophagus. Its sufferers may have trouble swallowing or feel as if food is stuck in their throat. (Dr. Mardini says he has seen strictures in young women after pregnancy.)

They’re usually treated by dilating the esophagus with an air-filled balloon. Occasionally surgery may be required, he says.

Another condition is Barrett’s esophagus, which causes the esophageal lining to look like that of the small intestine (a tissue well acquainted with stomach contents and built to handle them). Barrett’s raises the risk of potentially fatal esophageal cancer.

To diagnose both conditions, a doctor will do an endocopy, inserting a viewing scope through the nose or mouth to see the esophageal lining. A tissue biopsy is the next step.

Gastroenterologists are divided on when to do an endoscopy. Some believe that general screening isn’t needed because Barrett’s esophagus is rare. Current guidelines by the ACG recommend the procedure for patients with five or more years of chronic reflux.

Cell Changes and CancerThreatsLess than 10% of people with chronic acid reflux will develop the changes that lead to Barrett’s esophagus and fewer than 10% of Barrett’s patients get cancer.

Still, many doctors prefer to be cautious: Even the remote possibility of esophageal cancer merits testing, “because it’s deadly and there’s a way to look for it,” Dr. Mardini says.

Surgery is one option to remove diseased esophageal tissue, but it’s not a cure: It only relieves symptoms. Specialists also disagree about whether surgery before a cancer diagnosis is effective. Around 75% of cancer patients who undergo an operation end up with metastasis that already has spread to other organs, Dr. Horn says.

“The key thing here is to just be aware that no one should have heartburn,” Dr. Falk says. “If it’s situational, there are things you can do about it. If it’s occurring on a regular basis, it requires medical attention.”

What’s Your Indigestion IQ?
Far too many of us are familiar with the lingering discomforts associated with indigestion, heartburn, acid reflux, and other gastrointestinal issues. The good news is that you can take steps to prevent the unnecessary side effects brought on by certain behaviors. Do you know how? Take this indigestion quiz to find out.

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